I’ve worked for two decades in the healthcare industry, covering the bases among hospitals, medical groups, and managed-care organizations. I presently lead Gillikin & Associates, Inc., a small, independent consultancy focused on healthcare quality improvement. G&A specializes in health analytics, strategy for population-health management, and culture-of-quality infrastructure.

I worked for Priority Health, a top-ranked health plan with more than 700k covered lives, until May 2018. At PH, I managed a clinical analytics team that focused on:

• Exploratory analytics intended to improve outcomes, lower costs and promote better access to care
• Business case development and new-vendor assessments
• Population health analytics

Prior roles/experience within the health system include:

• Directly overseeing HEDIS 2016 for eight reportable lines of business covering more than 600k lives—including QA of our extract files, execution of the CAHPS sample frame, development of and attestation to the roadmap, MRR strategy and operations, IDSS reporting/attestation to NCQA and submission of PLD/PCR files to CMS.
• Coordinating reporting and operational support for a hospital case-management department that won the Franklin Award by ACMA in 2008.
• Leading a team of analysts providing technical systems and reporting services for facility revenue-cycle leadership.

I’m passionate about ways to improve the model of care delivery. I believe that the most significant path forward for driving material gains in quality and efficiency lies in population-health analytics that support individual wellness. The industry spends far too much time managing chronic disease instead of working seamlessly with providers and patients to avert chronic conditions through the careful identification of rising clinical risk. Through more sophisticated statistical modeling, more integrated datasets and a more effective application of behavioral economics, we can influence better long-term trajectories outside of the fairly narrow acute-care constraints of constructs like the Triple Aim. Although wellness as a business line has questionable ROI and effectiveness, the idea of engaging with people to remain healthy makes much more sense than waiting until they’re unhealthy and then focusing on disease burden.

In addition to my ongoing day-to-day work, I’m a former member of the board of directors of the National Association for Healthcare Quality. At NAHQ, I led a commission responsible for the recognition of the healthcare quality profession. Ex officio, I was a member of the board of trustees of the Healthcare Quality Foundation. I’m also a previous board member of the Michigan Association for Healthcare Quality and a frequent speaker at quality conferences around the country.

Through my NAHQ affiliation, I served as one of the national subject-matter experts in the development of the association’s health data analytics competency. I also served as a peer reviewer for the fourth edition of HQ Solutions, the definitive text about the profession and the best study guide for the Certified Professional in Healthcare Quality certification.

I’m honored to be considered a primary industry subject-matter experts about the application of analytic methods to quality-improvement initiatives. I frequently host webinars, conference sessions and informal talks about statistics, health information management and data-driven performance improvement.

I’m presently writing a book — Delivering MIRACLES: Structuring, Staffing & Supporting a High-Performing Healthcare Quality Team Using the MIRACLES Model — due in mid-to-late 2024.